Liu Shun, Mo Han, Zhao Yiqi, Chen Xiao, Wang Weiteng, Li Yijing, Zhang Ningning, Bao Mengni, Cui Zeyu, Zhao Qian, Yan Jun, Hua Xiumeng, Song Jiangping
Department of Cardiac Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, 167A Beilishi Road, Xi Cheng District, Beijing, 100037, China.
State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, China.
BMC Public Health. 2025 Jan 27;25(1):335. doi: 10.1186/s12889-025-21363-w.
Low family socio-economic status is a known factor that can contribute to increased mortality for patients with cardiovascular disease. However, in developing countries, the prognostic impact of socio-economic level on pediatric HTx is unclear.
We conducted a retrospective cohort analysis of children younger than 18 years who underwent heart transplantation (HTx) at our center from October 1, 2005, to May 31, 2023. To assess the impact of socio-economic status, we followed up with the discharged children until September 30, 2023, monitoring for all-cause mortality and unplanned readmission events. To evaluate the relationship between socio-economic status and prognosis, we assigned a composite score based on an assessment of household income, parental education level, and occupation. The Cox proportional hazards model and the Kaplan-Meier method were utilized for this analysis.
64 children (median age at operation 14 years, IQR 13-15) were enrolled and one case died in hospital due to primary graft dysfunction, 63 (98.4%) children had a median follow-up of 60 months (IQR 5.9-113.9). During the follow-up period, 10 (15.9%) children died, and 20 (31.7%) children had 25 unplanned readmissions. Children had higher all-cause mortality and more unplanned readmissions in families with low socio-economic status (n = 33) than middle (n = 10) or high (n = 20) family socio-economic status. Hazard ratios were 5.99,(95%CI:2.28-10.64, P = 0.003) for all-cause mortality for low versus high family socio-economic status, and 2.53 (95%CI:1.04-9.43, P = 0.029) for middle versus high family socio-economic status.
Lower family socio-economic status is associated with a worse prognosis than high family socio-economic status. Measures to alleviate economic disparities are needed to improve the prognosis of pediatric HTx.
家庭社会经济地位低下是一个已知因素，可导致心血管疾病患者死亡率增加。然而，在发展中国家，社会经济水平对小儿心脏移植（HTx）的预后影响尚不清楚。
我们对2005年10月1日至2023年5月31日在本中心接受心脏移植（HTx）的18岁以下儿童进行了回顾性队列分析。为评估社会经济地位的影响，我们对出院儿童进行随访至2023年9月30日，监测全因死亡率和非计划再入院事件。为评估社会经济地位与预后之间的关系，我们根据家庭收入、父母教育水平和职业评估分配了一个综合评分。本分析采用Cox比例风险模型和Kaplan-Meier方法。
纳入64例儿童（手术时中位年龄14岁，IQR 13 - 15），1例因原发性移植物功能障碍在医院死亡，63例（98.4%）儿童中位随访60个月（IQR 5.9 - 113.9）。随访期间，10例（15.9%）儿童死亡，20例（31.7%）儿童有25次非计划再入院。社会经济地位低的家庭（n = 33）中的儿童全因死亡率和非计划再入院次数高于社会经济地位中等（n = 10）或高（n = 20）的家庭。低与高家庭社会经济地位相比，全因死亡率的风险比为5.99，（95%CI：2.28 - 10.64，P = 0.003），中等与高家庭社会经济地位相比为2.53（95%CI：1.04 - 9.43，P = 0.029）。
家庭社会经济地位较低与高家庭社会经济地位相比，预后较差。需要采取措施减轻经济差距，以改善小儿心脏移植的预后。
